BY CATHERINE DONALDSON-EVANS | FEBRUARY 16, 2011

Study debunks need for aggressive breast cancer surgery

A common lymph-node operation done on many breast cancer patients may be unnecessary, according to new research that has rattled the medical community.

The study published last Wednesday in the Journal of the American Medical Association says that women with aggressive breast cancer who had several lymph nodes removed from under their arms had no better chance of survival or recurrence than those who didn't have the surgery.

Doctors in the field say the findings mark a dramatic shift in treating those suffering from the disease so that it doesn't spread or come back. For the past century, taking out armpit lymph nodes has been standard practice.

Researchers found that for about 20 percent of women with breast cancer, the frequently debilitating surgery has no clear benefit when it comes to the course of treatment, the risk of the tumors returning or spreading, or the chance of survival. That's good news for the many patients who develop complications after the procedure, including infections and a potentially crippling, painful swelling in the arm called lymphedema.

Current medical guidelines say that the surgery should be performed if the cancer has spread beyond the breasts to the lymph nodes.

The JAMA findings showed that women whose cancer had only spread to one or two nodes had just as positive an outlook when they bypassed the surgery as those who had many more nodes taken out.

The study involved a random clinical trial of about 850 women whose cancer had gotten into a lymph node or two. Half of them had the invasive procedure done to extract the nodes and the other half did not.

After five years, 92 percent of the patients in both groups were alive and 83 percent of the entire participant pool had no recurrence of their cancer. Seventy percent of those who had the operation experienced complications, including swelling and infections, compared with only 25 percent of the women who avoided it.

The researchers said the surgery proved unnecessary because the cancer in the nodes had probably already been eradicated by radiation and chemotherapy, which all the women in the study had gone through.

But some doctors are skeptical that the findings will stand the test of time, and criticize the research for its lack of more extended follow-up.

Some cancer treatment centers, like Sloan-Kettering, have already changed their practices because they knew about the National Cancer Institute-funded study ahead of its publication, the Times said.

What the research results mean is that only one or a few nodes will need to be taken from women's underarms to determine whether the breast cancer has spread and they need more treatment.

"This certainly is a pivotal study and an important additional piece of information in an area that we've been waiting for," Duke University's Dr. Gary Lyman, who was involved in writing the original guidelines, told the AP.

Those standards were recommended by the American Society of Surgical Oncology. Lyman said the organization is currently reviewing them and will probably make changes in light of the JAMA findings.